Baqsimi, Nayzilam, and Nasal Rescue Medications at School: What Parents Need to Know

Your child's neurologist prescribed Nayzilam for breakthrough seizures, or their endocrinologist wrote orders for Baqsimi in case of severe hypoglycemia. Both are single-use nasal sprays designed for rapid administration by trained school staff under the physician's orders. But the school is telling you they can't keep it on site, or that only a nurse can give it, or that your child needs to transfer to a school with a full-time health office.

None of that holds up under federal law.

Why Nasal Rescue Medications Changed the Game

Before intranasal options existed, emergency rescue meant rectal diazepam (Diastat) for seizures and injectable glucagon kits that required mixing and needle assembly for severe hypoglycemia. Schools had legitimate logistical concerns: privacy protocols for rectal administration and multi-step injection procedures that intimidated unlicensed staff.

Baqsimi (intranasal glucagon, 3mg) and Nayzilam (intranasal midazolam, 5mg) eliminated those barriers. Both are room-temperature stable, pre-loaded, single-use devices. Administration takes one step: insert the nozzle into one nostril and press the plunger. There are no needles, no mixing, no refrigeration, and no decision-making about dosage. Valtoco (intranasal diazepam) works the same way for seizure emergencies.

Their ready-to-use nasal delivery simplifies administration for trained school staff following the physician's orders. A designated staff member who supervises the student can be trained to administer the medication under the Seizure Action Plan or Diabetes Medical Management Plan.

What Schools Get Wrong

The most common refusal sounds like: "Our staff aren't licensed to give medications." This confuses routine medication administration (which some states do restrict to licensed personnel) with emergency rescue medication, which falls under a different legal framework entirely.

Under Section 504 of the Rehabilitation Act, a school district has an affirmative duty to provide trained personnel who can administer prescribed emergency medications during all school activities — including recess, PE, field trips, and bus routes. The school cannot require a parent to be present as a condition of the child attending, and it cannot limit emergency coverage to hours when a nurse happens to be in the building.

In California, American Nurses Association v. Torlakson (2013) settled this definitively: voluntary, trained unlicensed school staff can legally administer prescribed medications under physician orders. Most states have enacted similar Seizure Safe Schools legislation, and most U.S. states have epinephrine stock laws addressing emergency access.

How to Get Nasal Rescue Meds Into Your Child's 504 Plan

Start with the physician's order. Your child's doctor writes the Seizure Action Plan (for Nayzilam or Valtoco) or the Diabetes Medical Management Plan (for Baqsimi) specifying the medication, the trigger for administration, and the single-step procedure. This clinical document goes to the school — but it needs a 504 plan behind it to be enforceable.

The 504 plan should include specific language:

• Storage: The medication is stored in an unlocked, accessible location known to all trained staff — not locked in the nurse's office when the nurse is at another building.
• Trained personnel: At least three full-time voluntary staff members in the assigned building are designated and trained as the student's Trained Diabetes/Seizure Personnel, with coverage arranged for field trips, athletic events, and transportation. Training documentation is on file.
• Portability: A backup dose travels with the student to field trips, athletic events, and on the school bus.
• Timeline for administration: Staff administer the medication according to the physician's action plan without waiting for a nurse, parent, or 911 arrival.

If your child has both diabetes and epilepsy — not uncommon — the plan covers both Baqsimi and a seizure rescue medication, with clear protocols for each.

When the School Still Pushes Back

If the district claims it cannot train staff, ask for the refusal in writing. A written refusal to provide emergency medication coverage is strong evidence of a Section 504 violation. You can file a complaint with the Office for Civil Rights (OCR) or, following A.J.T. v. Osseo Area Schools (2025), pursue a Section 504 or ADA claim under the ordinary disability-discrimination standards. IDEA exhaustion is not required when the requested relief is unavailable through the IDEA administrative process, such as money damages.

Most schools comply once they understand the legal exposure. The goal is not confrontation — it is making sure that the person nearest your child during a medical emergency has a nasal spray in their desk drawer and knows how to use it.

The Medical 504 Plan Toolkit includes ready-to-use accommodation language for Baqsimi, Nayzilam, Valtoco, and injectable rescue medications, along with a training delegation request letter you can hand to the principal.